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Assisted Living: Medication Management and Administration

The goal of assisted living is to give residents more control of their lives. Helping residents take medications on their own is one way to do that. If they are able, residents should be trained to take medications on their own.

However, not all residents can manage their medications alone. They may need help from a staff member. When staff help residents take medications, they have to follow rules related to:

  • Training.
  • Record-keeping.
  • Packaging medication.
  • Storing medication.
  • Disposing of medication.

We offer resources and outline the regulations related to various tasks in different types of assisted living facilities.

Staff must make sure residents can take medications correctly. This includes checking their vision and if they can remember information. Staff should check residents every year and when there are changes in their health.

Resources

Staff can use the following tools to make sure residents can take their medications. Some are free, while others may need to be purchased.

University of Maryland School of Pharmacy Tools to Assess Self-Administration of Medication

Regulations

Helping residents take medications is an important part of staff training. When staff aren't trained correctly, it puts residents at risk.

Sometimes, RNs (registered nurses) have other staff members help residents with medication. The RN should make sure these staff are trained.

Resources

Regulations

Staff should keep track of the following:

  • All medications a doctor prescribes
  • All medications a resident receives and when
  • Any side effects to a medication
  • Any training staff have received
  • If a pharmacist has reviewed a resident's medications
  • How a medication was disposed
  • Errors in how a medication was given to a resident

Regulations

In assisted living facilities and adult day care settings, the regulations may indicate that a written order is required from a physician before staff can administer medications. 

There have been some questions about what constitutes a written physician order and there have been some barriers to obtaining a written physician order which can cause harm to residents. For example, a resident comes back from a physician visit on a Friday afternoon and has new medications. The facility however does not have orders and are unable to reach the physician to obtain them until the following Monday. Another scenario is when a facility receives printed orders from an electronic health record and the medication orders do not contain a written physician signature.

Analysis

  • Adult Day Care Center (ADCC)
  • Adult Family Homes (AFH)
    • Wis. Admin. Code § DHS 88.07(3)(d) - Before a licensee or service provider dispenses or administers a prescription medication to a resident, the licensee shall obtain a written order from the physician who prescribed the medication specifying who by name or position is permitted to administer the medication, under what circumstances and in what dosage the medication is to be administered.
  • Residential Care Apartment Complex (RCAC)
    • There are no regulations that specifically address physician orders for medications.
  • Community Based Residential Facilities (CBRF)
    • Wis. Admin. Code § DHS 83.37(1)(a) - There shall be a written practitioner's order in the resident's record for any prescription medication, over-the-counter medication or dietary supplements administered to a resident.

Result

A written practitioner order for specific medications can include the following:

  1. Written order mailed, faxed, or hand delivered from the practitioner.
  2. A medication administration record (MAR) signed by the practitioner that is faxed, mailed, or hand delivered.
  3. A copy of a prescription that is faxed, mailed, or hand delivered by the pharmacist. (Pharmacists have specific regulations that allow providing a copy of a prescription to a patient.)
  4. A MAR signed by the pharmacist based on prescription orders signed by physician that pharmacist has on file.
  5. An electronic order that is directly transmitted electronically to the facilities electronic health record (computer to computer transmission).
  6. A printed copy of the electronic order contained in the practitioner’s electronic health record that indicates the practitioner electronically signed the order. This printed copy is provided directly to the facility from the provider.
  7. A printed copy of the electronic order from the pharmacy with evidence of signature. The facility shall obtain one of the order types noted above within two business days. While waiting for an order of types 1-7 above, a facility can follow the instructions on the prescription label. This should happen only in situations where the pharmacy or physicians are unavailable to provide the written order.

*Please note that MARs, printed electronic orders, discharge summaries provided to the assisted living provider
from the practitioner may not always be compliant for pharmacy prescription laws. For these reasons,
pharmacists will need to contact the practitioner to obtain legal orders. When contact is made between the
pharmacist and the practitioner, orders may --- in some cases--- be changed to avoid delays in the availability of
medication. Assisted living facilities and pharmacists will need to communicate these changes and delays so that the assisted living facility has the current orders and has direction to delay administering the medication until available.

Staff should let a resident's health care provider know about changes to their health. They also should tell the resident's family or guardian.

Staff should report the following:

  • Any change in overall health
  • Negative side effects
  • Changes in medication dose

Resources

Reporting of Client, Patient, or Resident Death

Regulations

Who can help residents take medications in a residential care apartment complex?

RNs can help residents take medications. They also are responsible for helping residents manage medications. This includes storing, preparing, and monitoring the effects of medications.

RNs can assign some of these tasks to other members of the staff (Wis. Admin. Code § DHS 89.13(22)). No matter who performs tasks, Wisconsin Nurse Practice Act standards apply.

Can a community-based residential facility hire a nurse who only assigns injections?

Yes. However, the RN likely doesn't meet regulations (Wis. Admin. Code § DHS 83.37(2)(e) and Wis. Admin. Code § DHS 83.37(2)(b)).

RNs can assign tasks, such as injections, to staff at the facility. If the RN meets certain requirements, insulin can be in a vial or insulin pen. If not, the insulin must be in a unit dose packaging. This can be challenging for community-based residential facilities.

RNs who supervise others must (Wis. Admin. Code § DHS 83.37(2)(b)):

  • Manage how and when a resident receives medication.
  • Check the resident and their medical status.

Glossary

 
Last revised October 9, 2026